snus

Nicotine is the primary substance in cigarettes that causes addiction, but most experts agree that it does not directly cause cancer.

Most research points to cigarette smoke, not nicotine, as being the primary contributor to cancer among smokers. However, although most experts agree that nicotine does not directly cause cancer, some research suggests that nicotine may lead to a type of DNA damage that increases the risk of cancer.

Research from 2015 reported in the Indian Journal of Medical and Paediatric Oncology suggests that nicotine may increase the risk of cancer because it might damage DNA, initiate cancer and cause it to progress faster, and interact with cancer-causing chemicals.

Research into the role of nicotine in cancer is ongoing. Many studies, however, do not differentiate between nicotine, tobacco, or smoking when they discuss cancer risk. This makes it difficult to determine which of them causes cancer.

Even if nicotine does cause or lead to cancer, the risks of developing cancer through the use of nicotine-only products are much lower than the risks from smoking.

Methods of consuming nicotine and their safety

Nicotine is addictive and is the primary reason most people smoke. However, almost every other nicotine-based product is safer than smoking. No nicotine replacement product is completely safe for all people, but some of the less harmful alternatives include:

Nicotine replacement therapy
A person with a heart condition should speak to a doctor before undergoing NRT.
Nicotine replacement therapy (NRT) refers to a group of treatments designed to help smokers quit. NRT is available in several forms, each of which delivers nicotine without smoke, tobacco, or other carcinogenic (cancer-causing) chemicals:

The following types of NRT are available over the counter:

a patch, which delivers nicotine through the skin

chewing gum, which allows a user to chew and swallow nicotine

a lozenge, which slowly dissolves and releases nicotine into the mouth

Two additional forms of NRT are available with a prescription:

an inhaler, which allows users to take in nicotine in a similar way to inhaling it from a cigarette

a nasal spray, which delivers nicotine through the nose

NRT poses some risks. In addition to nicotine’s potential link to cancer, it is also a stimulant. This may make it unsuitable for some people with heart disease or certain heart disease risk factors to use.

However, most people who have a heart condition can use NRT. However, there is a small group of people who should not use NRT, such as those with severe arrhythmia, severe angina, or people who have recently had a heart attack. People should talk to their doctor for individual advice if they are in any doubt about using NRT.

Some people also use NRT as a means of consuming nicotine regularly, instead of for cutting down or quitting, and the long-term effects of NRT are not clear.

A 2010 study in the American Journal of Public Health concludes that the benefits of NRT far outweigh the risks. Researchers specifically state that increasing NRT use could save 40,000 lives per year by preventing heart disease and lung cancer.

Electronic cigarettes
Electronic cigarettes, or e-cigarettes, sometimes called vaporizers or vapes, all work by vaporizing nicotine. The amount of nicotine in each electronic cigarette varies; some even allow users to decide the amount of nicotine they use.

E-cigarettes have been the subject of dozens of safety studies in recent years, often producing conflicting results. A 2013 study found that amounts of nicotine vary with these products and that some may provide dangerously high, or even fatal, levels of nicotine.

Other research, including another 2013 study comparing several e-cigarette brands, found that they may contain toxic chemicals. When e-cigarettes do contain these chemicals, they are generally fewer in number and quantity than in traditional cigarettes.

Despite these risks, most studies agree that e-cigarettes are significantly safer than tobacco or smoking. A 2014 systematic review in the journal Therapeutic Advances in Drug Safety argues that smokers who switch to vaping can expect significant health benefits.

Smokeless tobacco
Researchers have linked chewing tobacco with an increased risk of cancer.
Smokeless tobaccos are chewed or put in the nose. They contain nicotine, as well as a range of other carcinogenic chemicals. According to the American Cancer Society, smokeless tobaccos are safer than cigarettes, but still have links to cancer.

Some types of smokeless tobacco include:

Snus or Swedish tobacco
Snus, sometimes called Swedish tobacco, is a moist powder form of tobacco. The user can suck on or chew the tobacco. Unlike chewing tobacco, people swallow it instead of spitting it out. According to the American Cancer Society, Snus may contain less nicotine than other types of moist tobacco types. However, because it is tobacco, it contains a variety of chemicals that may be carcinogenic.

A World Health Organization (WHO) analysis of previous research argues that snus is unlikely to cause oral or gastric cancer. As a result of this research, the WHO suggest that snus may be an important method of harm reduction.

However, not all research supports this claim. A 2013 case study reported on snus users in Iran who presented with oral cancer. The authors of that study argue that snus and other forms of smokeless tobacco significantly increase the risk of oral cancer. However, this risk appears to vary by region.

Overall the potential risks of snus are unclear.

Chewing tobacco
Chewing tobacco, sometimes called dip, allows a user to chew on or suck tobacco. Some people hold it between their cheeks and gum while tissues in the mouth absorb the nicotine. People then spit it out.

However, the American Cancer Society note that while users consume roughly the same amount of nicotine as people who smoke cigarettes, they also take in lots of dangerous chemicals.

The Society state that there are strong correlations between chewing tobacco and the development of oral cancer, pancreatic cancer, and esophageal cancer, as well as gum disease and other mouth health problems.

Quitting or cutting down on nicotine

Smokeless nicotine products that do not contain tobacco may offer a useful harm reduction strategy for many smokers, and also a way of reducing the side effects of quitting nicotine.

Smokeless nicotine products, such as NRT, provide the most significant benefit. Users should steadily reduce the amount of nicotine they use, or increase the time between each use until they are no longer regularly consuming nicotine and are not experiencing withdrawal or side effect symptoms.

Smokers who are unable or do not want to quit should still consider alternative forms of consuming nicotine. Though not wholly safe, e-cigarettes and vaping offer an experience similar to smoking, but with less exposure to harmful chemicals and an overall reduction in the risk of cancer.

Takeaway

Nicotine is a drug, and no drug can be completely safe — particularly at higher levels of consumption. People with heart disease or heart disease risk factors may be more vulnerable to the adverse effects of nicotine.

It is smoking and the many chemicals it exposes a person to, not nicotine itself, which presents the highest risk. Switching to a nicotine-only product does not remove all likelihood, but it greatly reduces the risk of cancer. People interested in trying these products can consider NRT or vaping, but not smokeless tobacco, as safer alternatives.

Not just cigarette smokers, those smoking e-cigarettes as well as consuming smokeless tobacco like chewing tobacco and more are at greater risk of developing oral cancer, shows a recent study conducted by University of California.

In case you think only cigarette smokers are at a higher risk of getting oral cancer, you are widely mistaken. A recent study has found that a wide majority of non-cigarette tobacco users as well those using electronic cigarettes are exposed to considerable level of carcinogen, as much as a cigarette user is exposed to. Not just that, shockingly smokeless tobacco users were found at a greater exposure to tobacco-specific nitrosamines (TSNA). The study has been conducted by the scholars from University of California, San Francisco.

What is Oral cancer?
Belonging to the head and neck cancer group, oral cancer is a type of cancer that grows in mouth or throat tissues and mostly hit the squamous cells of your mouth, tongue and lips. Oral cancer can of several types – lip cancer, tongue cancer, cancer in the inner lining of your cheek, gums, floor of the mouth and hard and soft palate. It is important to go to a dentist for a biannual check-up for early detection of oral cancer, experts say. Due to lack of awareness and adequate check-ups, oral cancer gets detected only after they spread to the lymph nodes of the neck.

The other risk factors
Apart from tobacco consumption, both smoke and smokeless and excessive alcohol consumption, there are several other risk factors that can put you to greater risk of developing oral cancer. Human papillomavirus (HPV) infection, chronic facial exposure to sun, a former diagnosis of oral cancer, a family history of oral or any other types of cancer, a depleted body immune system, inadequate nutrition, genetic syndromes are other risk factors for oral cancer. Shockingly, being male is another potent risk factor as studies have found males to be at a higher risk of developing oral cancer, twice as likely compared to women.

For the first time since it was given the power to regulate tobacco, the US Food and Drug Administration (FDA) has authorized marketing of a new product.

The agency said that eight new smokeless snus products, to be sold in the United States under the “General” brand name by Stockholm-based Swedish Match AB, are now authorized under the premarket tobacco application pathway, which was established by the 2009 Family Smoking Prevention and Tobacco Control Act. Snus cannot be marketed as “FDA-approved,” however.

“Today’s action demonstrates that the premarket tobacco application process is a viable pathway under which products can be marketed, as long as the public health can be protected,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products, in a statement.

This is the first time any tobacco maker has completed the rigorous premarket tobacco application review process at the agency; others have had products approved by proving they are substantially equivalent to what is already on the market.

The agency said that Swedish Match provided evidence that “these products would likely provide less toxic options if current adult smokeless tobacco users used them exclusively.” The agency also agreed with the company that snus’ availability would not result in substantial new use, delay quit attempts, or attract ex-smokers.

Swedish Match had been seeking separately to remove warnings that snus is harmful, but the agency has not yet ruled on that request.

In that separate application, Swedish Match was seeking to have the 10 types of snus it already sells in the United States designated as modified-risk tobacco products. The agency accepted the company’s application in August 2014 and held a meeting of its advisory panel to review the evidence in April 2015.

The company wanted to remove warnings that snus could cause gum disease and tooth loss or mouth cancer. It also sought to label its products with the statement that reads, “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.” The advisory committee could not reach consensus on whether snus was a safer alternative to smoking, and also was not convinced that the product would not attract new users. At that meeting, Dennis Henigan, director of legal and policy analysis for the Campaign for Tobacco-Free Kids, said Swedish Match had failed to show that users would not use both cigarettes and snus, or that young people would not initiate use.

Snus, which is ground tobacco, salt, and water, comes in a pouch that users place under their upper lip. It can be used for up to 30 minutes, according to the company. It is popular in Sweden, but less so in the United States. Swedish Match says its General brand accounts for 11% of American convenience store snus sales. The 60 million cans it sells annually in the United States are dwarfed by the billion cans of smokeless tobacco sold.

The Centers for Disease Control and Prevention estimates that less than 4% of adults use smokeless tobacco, with rates highest among men aged 18 to 25 years (10%). A 2014 Centers for Disease Control and Prevention survey of high school students found that 5.5% of overall used smokeless tobacco, and an additional 1.9% reported current use of snus.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Associations Between Initial Water Pipe Tobacco Smoking and Snus Use and Subsequent Cigarette Smoking: Results From a Longitudinal Study of US Adolescents and Young Adults

Importance Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes.

Objective To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking.

Design, Setting, and Participants We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non–cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non–cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initiation and current cigarette smoking, accounting for established sociodemographic and behavioral risk factors. We fit similarly specified multivariable ordinal logistic regression models to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with high-intensity cigarette smoking at follow-up.

Exposures Water pipe tobacco smoking and the use of snus at baseline.

Main Outcomes and Measures Among baseline non–cigarette smokers, cigarette smoking initiation, current (past 30 days) cigarette smoking at follow-up, and the intensity of cigarette smoking at follow-up.

Conclusions and Relevance Water pipe tobacco smoking and the use of snus independently predicted the onset of cigarette smoking and current cigarette smoking at follow-up. Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking.

An FDA advisory panel were reluctant to recommend a gentler warning label for one brand of smokeless tobacco products at a committee hearing on Friday.

Swedish Match North America (SMNA), the first company to be considered for a modified risk tobacco designation by the FDA, is asking to replace a current label warning, “This product is not a safe alternative to cigarettes,” with this: “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

It also wants to drop warnings required for other smokeless tobacco products about oral cancers, tooth loss, and gum disease.

Many members said the health risks were lower for certain tobacco-related illnesses, but not for all health concerns. Those who disputed the claim argued that it could not be taken as a “global statement” — as there are known risks to pregnant women and uncertain risks for adolescents.

As for the proposed label change, the whole committee agreed that the sponsor’s statements would not suffice. Gary Giovino, PhD, chair of the department of Community Health and Health Behavior at the State University of New York at Buffalo, felt the statement was “dismissive of the health risks.” The word “but” in any sentence seems to negate the first half, he said.

Snus is a finely ground smokeless tobacco powder in a filter packet that is placed under the upper lip.

In his opening remarks on Thursday, Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products, said that in the past companies alone decided how to advertise their products — a practice which proved damaging to consumers’ health. “Now it’s the FDA who serves as the regulatory gatekeeper, standing between consumers and the companies seeking to make claims about their products.”

To meet the standards of a modified risk tobacco product, Zeller explained, “Applicants must not only demonstrate that the products, as actually used by consumers, will significantly reduce risks to individual users of those products; they must demonstrate that they will benefit the population as a whole – taking into account both users and non-users of tobacco products.”

In its application, Swedish Match has asked to revise the labels for 10 snus products. It would maintain its warning that smokeless tobacco is addictive.

Oral Safety Unproven
The committee was unmoved by the firm’s evidence related to gum disease and tooth loss and voted 8-0 against supporting a conclusion that snus products “do not pose a risk of gum diseases or tooth loss.”

Or as Thomas Novotny, MD, MPH, the graduate school of public health at the University of California San Diego State said, when explaining his vote, “It’s not causal relationships that we’re after, it’s perception of risk and the studies don’t rule that out.”

The committee’s vote was likely influenced by Scott Tomar, DMD, MPH, DrPH, of the department of Community Dentistry and Behavioral Science, at the University of Florida, who said that “advanced gingival recession can result in tooth loss.” One of the studies presented showed a relationship between gingival recession and snus use.

As to whether snus products also “do not pose risks of oral cancer” to consumers, the committee was split 3-3 with two abstentions.
“I think the data are tending towards no increased risk but I’m not quite ready to go there,” said Giovino, one of the abstainers.

Pebbles Fagan, PhD, MPH, associate professor and member of the Cancer Prevention and Control Program at the University of Hawaii, said that based on the absence of women in the larger cohort studies, she was not comfortable claiming that snus products posed no risk of oral cancer.

Can the ‘Swedish Experience’ Cross the Ocean?
Perhaps the most important questions the committee voted on was whether the proposed labeling change would help or harm consumers. Swedish Match threw the weight of its argument behind the “Swedish Experience,” a series of government, academic ,and industry studies showing a dramatic shift from cigarette smoking to snus in the mid-1990s. The firm argued that Swedish men reduced their risk of tobacco-related diseases.

But asked whether American tobacco users would likely follow suit — swapping cigarettes for snus — panel members were unconvinced.

Only one committee member said such a switch was likely, against six voting against and one abstention.

Richard O’Connor, PhD, associate professor of oncology at the Roswell Park Cancer Institute, in Buffalo New York, the lone panelist to agree that the experience in Sweden might translate to the U.S., said the data informed “a potential pattern in the U.S.”

Another subpopulation of obvious concern is adolescents. Timothy McAfee, PhD, MPH, director of the Office on Smoking and Health at the CDC, cited animals studies on tobacco addiction that showed “deleterious effects on adolescent brain development.”

On the plus side for Swedish Match, the majority of the committee felt it unlikely that nonusers of tobacco would pick up the snus habit, although three committee members abstained from this question because they did not believe there was enough data to support such a scenario.

Lars-Erik Rutqvist, the senior vice president of scientific affairs at Swedish Match said the company was pleased with the discussion at the hearing. “On the whole they seemed to accept the fact that there is a considerable risk reduction in our products and of course that’s very important. It’s part of the definition of a modified risk product.” Rutqvist added that he would expect to continue discussions with the FDA while awaiting their decision this summer.

“I look forward to the path forward for us.”

The FDA is not required to follow the advice of its advisory committee but it usually does.

As anti-tobacco advocates celebrate today’s Great American Spit Out — the “chew” equivalent of the Great American Smoke Out — health officials warn that new dissolvable and flavored varieties of smokeless-tobacco products are targeting teens in a mission to get them hooked.

Newly released data from state health researchers show that, while cigarette smoking among Florida youth has reached an all-time low, smokeless tobacco use has been virtually unchanged for the past decade: roughly 5.5 percent among high school students statewide.

And it’s nearly 9 percent in some counties, including Lake.

“The tobacco industry is targeting us,” said Magi Linscott, a Pensacola-area 18-year-old named National Youth Advocate for 2014 by the Campaign for Tobacco-Free Kids. “They’re trying to get a new generation of addicts.”

Recent product developments include colorfully packaged, kid-friendly flavors of tobacco-infused candy, mints, gum, breath strips and flavored toothpicks — all containing nicotine. Depending on the type, they are designed to be held in the mouth, chewed, or sucked until they dissolve and the juices swallowed.

Along with more traditional chew, snuff and a teabag-like pouch of finely ground tobacco called snus (“snoose”), smokeless products may lure users with a false sense of safety. Shannon Hughes, Tobacco Free Florida bureau chief, said young people — and their parents — may not realize the dangers of the products, which increase the risk of oral cancer by 80 percent.

“Adults think, ‘Well, at least they’re not smoking,'” Hughes said. “Yes, cigarettes do cause more systemic damage to the body. But smokeless tobacco dramatically increases the risk of oral cancer, which is horribly disfiguring, and a horrible way to die. The bottom line is: There’s no safe level of tobacco use.”

The Spit Out — aimed at raising awareness of the problem — is part of a national “Through with Chew Week.” But because no single agency sponsors the campaign, it lacks the name recognition of the Smoke Out, officials admit.

Chew and snuff have long been popular among baseball players and in rural communities, where their use is sometimes a rite of passage. Among local high-school students surveyed last year, only 3.1 percent of those in Orange County said they currently used smokeless tobacco, while the rate was 4.2 in Osceola, 5.3 in Seminole and 8.9 percent in Lake.

Use is vastly more common for males than females and for whites than blacks or Hispanics.

“It’s part of the culture in certain areas,” Hughes said. “And it can be easier to conceal,” especially with the newer forms. It is also cheaper than cigarettes.

But the American Cancer Society warns that because U.S. tobacco sellers are not required to list what’s in their products, it’s hard to know exactly how hazardous the smokeless varieties can be.

The World Health Organization has identified at least 28 carcinogens in smokeless tobacco, and along with the heightened risk of oral cancer, there’s a 60 percent increase in the risk of esophageal and pancreatic cancers compared to non-users. The products also raise the risk of heart disease and fatal strokes and may impact reproductive health, Hughes said.

“And because youth are often most concerned with the immediate impact,” she said, “we point out that smokeless tobacco use can cause tooth decay, permanent discoloration of teeth and gingivitis leading to tooth loss.”

Perhaps most disconcerting is the increased likelihood of stepping up to more lethal forms of tobacco. Researchers found smokeless-tobacco users tend to experiment with smoking and are more likely to become addicted. The younger the user, scientists say, the more sensitivity to nicotine.

SAN DIEGO – One of Tony Gwynn’s last acts was issuing a simple message about the habit he blamed for his cancer.

About two and half months ago, Gwynn received a request from the Professional Baseball Athletic Trainers Society – known as PBATS – to do a taped interview on the dangers of spit tobacco to be shown to players.

“It came back that Tony was entirely sick to do that,” said Neil Romano, adviser to the PBATS.

Gwynn blamed his decades-long use of chew tobacco for his mouth cancer.

On May 28, less than three weeks before Gwynn’s death, the group got final confirmation through his agent that they could use an emailed statement.

Gwynn’s message: “My advice to anyone would be if they aren’t using spit tobacco, please don’t start. And if you are using, try to quit, if not for yourself then do it for the people you love.”

“The fact that this was one of his last acts goes to his class, his character as a person, and frankly, his love for the game and the players,” said Romano.

When Gwynn was first diagnosed, Major League Baseball banned players from putting tins in pockets and using during interviews, but usage during games is still allowed.

Mark Grudzielanek retired in 2010 after a 15-year career. He never used but said when he started, it was readily available through clubhouse staff.

“Whatever we needed, they went and got it,” said Grudzielanek.

Romano says more than a decade ago, MLB started cracking down on that practice. Chew was also banned in the minors.

About a third of major league players still dip. Critics say that is a prime reason why a federal study found that 20 percent of high school boys chew.

Grudzielanek hopes Gwynn’s final message will make a difference. The five-minute film, which also commemorates Gwynn, was completed on June 13.

A few days ago, Gwynn protégé and pitcher Stephen Strasburg said he is quitting chew for his daughter.

“It’s taken lives and let’s hope this is the last life, and we can control this and get these guys to understand how bad it is for you,” said Grudzielanek. “To stop kids from doing it, it has to stop from the top.”

In recent days, some have called for a spit tobacco ban to be looked at with a new MLB player labor agreement in 2016.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

New research casts doubt on nicotine’s safety—even if you aren’t smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.

”The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association.

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants

”Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

THURSDAY, June 5, 2014 (HealthDay News) — Cigarette smoking continues to decline among Americans who work, but use of smokeless tobacco — a known cause of cancer — has held steady since 2005, U.S. health officials reported Thursday. Certain types of jobs — construction and mining, especially — are hotbeds of smokeless tobacco use, according to a study conducted by the U.S. National Institute for Occupational Safety and Health. Looking at tobacco use over five years, the researchers found a decline in cigarette smoking among working adults — from about 22 percent in 2005 to 19 percent in 2010. But use of smokeless tobacco products such as chewing tobacco and snuff inched up slightly — from 2.7 percent in 2005 to 3 percent in 2010.”These findings can help health professionals direct assistance to working men and women to stop using smokeless tobacco, a known cause of oral, esophageal and pancreatic cancer,” the researchers from the U.S. Centers for Disease Control and Prevention reported. The CDC called on employers to try to snuff out all forms of tobacco use. New smokeless tobacco products such as snus (finely ground moist snuff) and candy-flavored dissolvable tobacco, combined with increased marketing, might explain smokeless tobacco’s steady use, the CDC authors said. However, snus and some other products weren’t included in the questionnaire so it’s possible smokeless tobacco use is underestimated, study author Dr. Jacek Mazurek, of the division of respiratory disease studies, and colleagues noted. Chewing tobacco and snuff aren’t safe, research has shown. These products may contain more nicotine than cigarettes, according to the U.S. National Institutes of Health. Nicotine is highly addictive, which is why it’s so hard to quit smoking. For the report, researchers analyzed data from the National Health Interview Survey. About 19 percent of mining workers acknowledged use of smokeless tobacco, the survey found. Adults involved in oil and gas extraction also reported heavy use of smokeless tobacco, with about 11 percent using the products, according to the study published in the June 6 issue of the CDC’s Morbidity and Mortality Weekly Report. The percentage of cigarette smokers who also use smokeless tobacco was relatively unchanged during the study period — about 4 percent, the researchers said. Employers can step up efforts to curb smokeless tobacco use, the CDC suggested. Making workplaces tobacco-free, offering information on the health risks of tobacco and the benefits of quitting can help reduce these destructive habits. Promoting work-based tobacco-cessation services, including health insurance that covers treatment for tobacco dependence, is another valuable aid, the CDC report said.The finding that 3 percent of working adults used smokeless tobacco in 2010 indicates that much work is needed to meet the Healthy People 2020 target of 0.3 percent or less for U.S. adults.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

The number of smokeless tobacco products sold in Massachusetts is soaring, as are the levels of nicotine packed into many of them, according to a new analysis from UMass Medical School and the Massachusetts Department of Public Health (DPH).

“Nationwide, cigarette smoking control has been very successful and we have experienced a steady decline, but that success is being offset by the increased use of smokeless tobacco products, especially by youth,” said UMMS statistical scientist Wenjun Li, PhD. Dr. Li, associate professor of medicine in the Division of Preventive and Behavioral Medicine, co-authored the paper with colleagues from the DPH.

Published in the journal Tobacco Control, the study examines ten years of product data (from 2003 to 2012) that Massachusetts law requires tobacco manufacturers provide to the DPH. Notable findings include a nearly 30 percent increase in the number of moist snuff products and a nearly sixfold increase in the number of snus products sold in Massachusetts; these increases correlate with rising use among high school students.

Nationwide, more than one in eight males in the 12th grade uses smokeless tobacco. In Massachusetts, use among high school students has more than doubled since 2001. A wide variety of smokeless tobacco products on the market include newer inventions like dissolvable lozenges, snus and moist snuff, many of them flavored and colorfully packaged to appeal to youth, along with more traditional forms used by adults including chewing tobacco and dry snuff.

Researchers were particularly interested in unionized, or free nicotine, the form that is most easily absorbed in the mouth. The amount of free nicotine and how it is delivered in both smokable and smokeless tobacco products is associated with a product’s addictive potential—and is determined by modifiable design features as well as the amount of nicotine contained naturally in the tobacco leaf.

They found that while nicotine levels varied, free nicotine increased for several manufacturers. Li and DPH lead author and research analyst Doris Cullen,MA, believe that these as-yet inexplicable variations in nicotine content support the argument that free nicotine levels are controlled in the manufacturing process, and suggests that manufacturers are manipulating products’ addictive potential.

“The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products,” said Cullen.

“Smokeless products are easier for youth to access and use than cigarettes, and harder for parents to monitor,” said Li. “Even though they have less nicotine than cigarettes, more of that nicotine is readily absorbed, making snus and moist snuff a gateway to nicotine addiction and, possibly, future smoking.”

While the study did not focus on smokeless tobacco marketing, he noted that packaging products to look like candy also suggests that the tobacco industry is specifically targeting youth.

“This study supports that the tobacco industry’s manipulation of product design extends to smokeless products,” said corresponding author Lois Keithly, PhD, director of the DPH’s Massachusetts Tobacco Cessation and Prevention Program. “Considering the potential risk for nicotine addiction associated with the use of smokeless tobacco products, and the aggressive marketing of these products, it is critical to continue and expand surveillance of smokeless products at the state and national levels.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.